Erik Middlebrooks, MD
@EMiddlebrooksMD
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Professor & Associate Chair @MayoClinic , Consultant Neuroradiology & Neurosurgery. President @theSENRS . Treasurer @theASFNR . Senior Editor @theAJNR
Jacksonville, FL
Joined June 2019
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Ok, people wanted more brain candy so here are better views of
#7T
CE-MRV at 300 micron isotropic resolution.
#MayoClinicFlorida
@SiemensHealth
#Terra
MR CE Venogram on 3T compared to 7T
@SiemensHealth
Terra.
#NeuroRad
#neurotwitter
#Neurology
#radres
#medtwitter
31
295
1K
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511
2K
MR CE Venogram on 3T compared to 7T
@SiemensHealth
Terra.
#NeuroRad
#neurotwitter
#Neurology
#radres
#medtwitter
31
295
1K
Excited to share my approval of promotion to Professor in
@MayoClinicSOM
! Becoming youngest Professor in my department at a school that didn't offer me an interview as a pre-med is proof you don't have to be smartest, just willing to work hardest and not afraid to fail! 1/
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39
1K
Check out our 11.7T MRI of the midbrain at 100 micrometer resolution! Full publication on DBS targeting to be released soon in
@NeurosurgeryCNS
!
@MayoRadiology
@UFMDC
@TheASNR
@theASFNR
#MedEd
#NeuroRad
#DBS
@KDFooteMD
@MichaelOkun
@van_mila
20
158
440
Impressive how well the anterior nucleus of thalamus can be seen on T2 SPACE with right parameters at
#7T
MRI…also impressive how asymmetric in position in this case!! 🪦 R.I.P. indirect
#DBS
targeting! 🪦
#epilepsy
#MayoClinicFlorida
@MayoRadiology
#Terra
@SiemensHealth
20
44
260
While there is a DDx for this tiny lesion on 3T SWI in this
#epilepsy
patient,
#7T
T2* leaves little doubt in the diagnosis!
#MayoClinicFlorida
@MayoRadiology
9
27
172
#DBS
targeting has made monumental leaps with
#7T
MRI. Our newest pre-DBS sequence done in a
#Parkinsons
patient undergoing GPi DBS—0.5mm isotropic in less than 10 mins showing exquisite subcortical anatomy!
#MayoClinicFlorida
#Neurosurgery
@MayoRadiology
@SeizureSurgeon
4
33
168
Excited to start next part of my journey as Associate Chair at
#MayoClinicFlorida
! Our teams have been leaders in translation of state-of-the-art clinical imaging & I’m excited to help them build a grand vision for the future with our awesome Chair,
@CandiceBolanMd
!
17
9
155
Central vein sign is a powerful biomarker for
#MS
. Excited to share largest study to date on CVS at 7T & comparison with 3T! CVS detected in 87% of all lesions at 7T vs only 31% at 3T! 7T also 100% sens/spec for
#MS
diagnosis.
@OkromelidzeLela
@TheAJNR
6
51
152
At
#MayoClinicFlorida
, we are excited to celebrate over 1000 clinical
#7T
scans! 🎉 After reviewing all 1000, I remain blown away at the number of diagnoses made or changed for our patients—and we’ve only scratched the surface! A superb & experienced team is critical to success!
9
20
146
3D-EDGE at 7T with 0.4 mm isotropic resolution is stunning! And easily paired with 0.4 mm MP2RAGE to maximize detection of subtle dysplasia!
@SiemensHealth
#Terra
@MayoRadiology
#MayoClinicFlorida
#epilepsy
4
22
132
Isn’t the hippocampus a beautiful thing? I mean, it is almost as fascinating as the thalamus!
#hippocampus
#NeuroTwitter
#epilepsy
13
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129
7-T MRI: Providing Hope by Seeing the Previously Unseen
#MayoClinicFlorida
#NeuroRad
#NeuroTwitter
@MayoClinic
@MayoRadiology
3
31
127
I have seen this circulating a lot lately. It is very important that we acknowledge this IS NOT how language works! Even down to the fact that Broca area does not = Broca aphasia and Wernicke area does not = Wernicke aphasia! 1/4
2
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128
Vowed to avoid “post-Professor” apathy by publishing 52 articles (1/week) in Year 1 after promotion. Only 46 released, but had
#52
accepted just in time! Counting it! Truth be told, it’s work of so many collaborators & mentees, which is even more meaningful to me! 🧵 1/4
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4
127
I’ve been fortunate in my career to have so many renowned mentors that have heavily influenced my path. It wasn’t by chance! Now as a mentor to others, I have a much better understanding of the do’s and don’ts of being a mentee. An opinion 🧵 on how I got my foot in door. 1/25
6
26
126
Big congratulations to
@phudge54
for receiving the 2022
@TheASNR
Gold Medal! Well deserved! We are fortunate to have you as part of our team and fellowship program at
#MayoClinicFlorida
!
@MayoRadiology
@MayoClinic
@MayoClinicNeuro
#NeuroRad
18
15
123
So proud of my awesome research team for their publication that made the cover
@TheAJNR
! They never cease to amaze me with all they accomplish!
@cyndlg
@AyushixJain
@SAliMontazeri
@OkromelidzeLela
And thank you
@TheAJNR
&
@TheASNR
!
@MayoRadiology
@MayoClinic
@MayoFL_RadRes
9
14
121
A bittersweet day as I officially hand over
#MayoClinicFlorida
#NeuroRad
fellowship to these incredible educators!
@Alok_A_Bhatt
will be PD and
@AmitDesaiMD
will be Assoc. PD! We have assembled a world class team of educators & trained some of most phenomenal fellows I have had
6
6
120
Working on some
@theASFNR
programming material for
#ASNR2021
–I will try to disentangle this! Can’t wait to see all the exciting content this year!
@TheASNR
@MayoRadiology
#NeuroRad
#radres
#neurotwitter
3
16
114
Just doing some tinkering on
#7T
and liking this anatomy of STN and SN! Isotropic 0.3 mm resolution useful for STN targeting—with spin echo to reduce blooming of boundaries? SN pathology? 🤔
#Parkinsons
#DBS
#neurotwitter
#MayoClinicFlorida
7
22
112
As a PD, I’m glad to have the support of my institution in providing for our trainees.
@MayoClinic
GME has now substantially increased trainee salary TWICE in just 6 month period! Important recognition of the hard work & dedication of our trainees during these challenging times!
0
13
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@danmurrayserter
Consider at least giving credit to the people who spent a great deal of time and effort to develop the images that you use without permission!
Ok, people wanted more brain candy so here are better views of
#7T
CE-MRV at 300 micron isotropic resolution.
#MayoClinicFlorida
@SiemensHealth
#Terra
62
511
2K
7
8
110
First study exploring the impact of 7T vs 3T MRI on DBS outcomes for tremor: Our study shows 7T offers superior precision, improving tremor reduction & requiring lower stimulation current!
@TheJNS
@MayoRadiology
#MayoClinicFlorida
🧵
1
32
108
Excited to share our latest work on
#brainmapping
to explore role of uncinate fasciculus. Role of UF heavily debated. Using precision mapping & testing, we shed further light on its function.
@DSabsevitzPhd
@SeizureSurgeon
@DoctorQMd
#neurosurgery
1/5
7
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110
Excited to finally share real-world results of our translation of 3D EDGE to
#7T
MRI! 50% reduction in voxel volume still with ~2x SNR as 3T!! A powerful tool for FCD detection in
#epilepsy
that is easily integrated into existing sequences.
@MayoRadiology
3
23
108
Radiologist responding to the code blue in MRI…
3
8
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Yes, but does your conference have this view in the main conference room? 🇵🇹 Thanks to
@ChampalimaudF
for hosting
@ISMRM
Ultra-High Field 2022! Beautiful campus!
#7T
#neurotwitter
10
5
106
Happy to share another milestone of
#MayoClinicFlorida
7T program—now having performed >2,000 clinical
#7T
exams! 500+ epilepsy evals, 600+
#MS
patients, & many others! Amazed by how many patients’ lives changed already, but best is yet to come! More exciting news coming soon!
7
10
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Excited to share our latest work using synthetic image generation for common
#DBS
targeting sequences! From a single MP2RAGE acquisition, we can create T1, FGATIR, EDGE, GM nulled, etc. & also optimize image contrast.
#neurotwitter
#NeuroRad
7
26
101
New toy being installed in our
#MayoClinicFlorida
outpatient
#neuroscience
building—7T Terra!
@SiemensHealth
@MayoClinic
@MayoRadiology
@MayoClinicNeuro
3
7
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Great work by
@paosmeade
,
@MarencoLina
, &
@OkromelidzeLela
! Further evidence that “Broca” cortex is less critical than historically considered & often safely resected when underlying WM tracts spared.
@kchaichanamd
@DoctorQMd
@EMiddlebrooksMD
#neurotwitter
1
22
94
Excited to be
@NIH
to speak about
#neuromodulation
and hear about some of the most exciting cutting-edge science from around the world! First up, creating accurate models of current flow in the brain with Axel Thielscher!
@ISMRM
@MayoRadiology
1
6
97
Yet another case showing superiority of EDGE in detecting the most subtle FCDs over other sequences including DIR! This case caught by
@AmitAgarwalMD
!
#7T
#EDGE
#MayoClinicFlorida
#NeuroRad
#Neurosurgery
#epilepsy
@SeizureSurgeon
@MayoRadiology
@MayoClinicNeuro
3
21
96
Anyone ever eaten a Biscoff cookie while on the ground? ✈️ 🍪
43
1
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It has been 10 years since I first had the opportunity of a lifetime to work with Prof. Rhoton’s lab for over 2 years—challenging me in ways I had never been, in an endless pursuit to find beauty & perfection in the brain. Relationships forged in this lab continue to this day
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1
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@pipcosper
As my mentor
@MancusoMD
once said to me: “If people readily accept your research, it probably isn’t that important or correct!” Bigger discovery=bigger skepticism. Its human nature to not easily accept things that go against all we’ve believed. Don’t let rejection slow you down!
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We are super excited to welcome Vishal Patel, MD, PhD to
#MayoClinicFlorida
team as our newest
#NeuroRad
to further advance our Ultra-High Field MRI and
#AI
programs!
@MayoRadiology
@MayoClinicNeuro
6
9
88
Some clinical experiences using ultra-high res (300 micron) CS TOF MRA at
#7T
led by
@dhairyalakhani
🎉
Substantial gain in small vessel pathology with 7T (left images) vs 3T (right images)
#MayoClinicFlorida
@jsandhu11
@MayoRadiology
@TheNeuroradJour
3
18
83
Interested in a post-doc position in
#7T
MRI starting 2023? High-volume 7T practice with ~1,000 clinical cases per year—great opportunities for 7T translation! 7T experience highly preferred or relevant background in neuroimaging analysis. Contact me if interested!
#neuroimaging
2
30
87
Seems like not so long ago I joined this exciting ride with a group of people determined to push
#MayoClinicFlorida
to the forefront of neuroscience! Mission not over, but proud of all that has happened in my 5 years! A great team
@jmarkdoc
@KentThielen
@DoctorQMd
@MayoClinic
7
5
85
Reviewing year-end data and proud to see that we have nearly 700 clinical 7T scans over past year at
#MayoClinicFlorida
! So many changed diagnoses and new options for patients! And also a rapidly growing and amazing 7T team with 3 new faculty members!
@MayoClinic
6
10
81
Sometimes the only way to end a long, busy week is to just dance! Happy Father’s Day to all the great dads out there!
#DaddyDaughterDance
#FathersDay2021
#Princess
4
1
82
Patients with prominent hippocampal dentation are subject to volume averaging even in high res 3T COR T2, as in this case, that led to concern over loss of architecture. Ultra-high res T2 at
#7T
is able to easily resolve this as normal.
#MayoClinicFlorida
#NeuroRad
#Epilepsy
4
13
79
#7T
MRI a powerful tool in diagnosis of
#PD
, allowing high res evaluation of substantia nigra in vivo. A patient with severe right upper & lower extremity
#Parkinsonism
shows asymmetric reduction in neuromelanin w/ increased iron deposition in left nigrosome 1.
#MayoClinicFlorida
0
24
73
Honored to work with such an outstanding team on this project! A single tract was predictive of outcome in ET DBS in 2 cohorts & unifies variations in previously reported “sweet spots.”
@MayoRadiology
@FixelInstitute
@leaddbs
#Neurosurgery
#NeuroRad
#DBS
1
17
74
Today marks 13 years! Truly my better half—the most patient, kindest, selfless, and smartest person I know and daily reminder to be better!
#anniversary
#ValentinesDay
15
1
72
What I try to teach mentees about abstracts:
1) Don’t waste time on abstract that is unlikely to yield a publication.
2) Write the paper draft then copy and submit abstract. If you do the opposite order, >85% chance you won’t do the paper based on review of many CVs!
3) Don’t
2
14
72
Happy
#Halloween
!! 🎃
I surprised my daughter this year by dressing up to match her theme!
My most elaborate costume but I will be picking spirit gum out of my beard until retirement!
3
0
72
Not sure I am deserving of being included with such amazing members, but honored to have chance to support
#TheCortexClub
and the amazing work done by
@MohitAgNeurorad
in raising education and interest in
#neuroradiology
! And great work by his daughter in design and packaging!
2
3
71
Hanging out with the legend and
@theASFNR
President
@hsairmd
trying to absorb as much about rs-fMRI, life, and leadership from the master! I gave some tips on 🥩, but that is all I can teach him!
🇦🇷
#BuenosAires
🇦🇷
1
3
71
Honored for the opportunity to spend the day visiting
@MGHImaging
@harvardmed
today to discuss
#7T
imaging and many other hot topics! Amazing faculty doing a lot of great things! Not to mention a very entertaining group! 🧠
1
2
71
3
0
70
Too often I hear that
#NeuroRad
job in neurodegenerative disease is to “rule out tumors and strokes.” Don’t sell yourself short! We can make a major difference in the care of these patients! Missed clinical and imaging diagnosis can lead to incorrect prognosis and treatment!
8
17
67
A game changer in our
#epilepsy
practice! Better contrast for the more apparent Type II FCDs, but more importantly, far more sensitive to elusive Type I FCD. T2 approaches, like FLAIR & DIR, offer little gain in Type I which lack balloon cells & dysmorphic neurons that give T2
1
17
67
The precision of routine 7T
#fmri
is quite impressive! Still haven’t broken it—so have a ways left to “improve” 😆
#MayoClinicFlorida
@MayoClinicNeuro
@MayoRadiology
#7T
#NeuroRad
6
4
67
New to functional imaging or just want to learn more about brain functional anatomy? Check out this overview of some key functional anatomy coauthored with
#fmri
expert Behroze Vachha!
@RadClinics
@MSKCancerCenter
@MayoRadiology
#RadRes
#NeuroRad
0
18
66
Congratulations to
@Alok_A_Bhatt
on yet another education award! He is a tremendous asset to our
#NeuroRad
fellowship and
@MayoFL_RadRes
! We are running out of awards to give him…
5
10
64
@RogueRad
I’m going to say it...”AI” in radiology has probably helped academic careers far more than it has helped patients!
10
8
64
Amazing detection of fiber orientations through this glioma corresponding to expected anatomy using GQI and grid sampling scheme. Credit to collaboration with
@FangChengYeh
, a true ‘Michelangelo’ of tractography!
#tractography
#neurosurgery
#MayoClinicFlorida
@MayoRadiology
1
6
62
#fmri
is routinely used in pre-surgical mapping for tumors & lots of optimism, but what is the ACTUAL evidence for fMRI? You might be surprised! Check out our review by
@dhairyalakhani
on what we do & do not know!
@radiology_rsna
@MayoRadiology
0
15
63
We are thrilled to expand advanced imaging capabilities to our patients at
#MayoClinicFlorida
with installation of the first FDA-approved 7 Tesla MRI in Florida! Such an awesome engineering feat to witness!
@MayoRadiology
@MayoClinicNeuro
@MayoFL_RadRes
3
9
63
Deeply honored for opportunity to share stage in Shanghai with so many pioneers of MRI—Kamil Ugurbil, Seong-Gi Kim,
@dannywang
, & more! Never been more excited about the future of neuroimaging!
#NeuroRad
#7T
2
4
63
Great experience partnering with 🚀 AX-1 mission crew
@CommanderMLA
and Pilot Larry Connor at
#MayoClinicFlorida
! Excited to see the great things coming from
@Axiom_Space
in the future—a fantastic company!
@MayoRadiology
2
4
63
Dr. Wintermark (
@theAJNR_EIC
) is a model leader—a prolific academician who is never too important to speak to anyone or listen to their opinion & promotes career of others. One of many leaders that make
#NeuroRad
the best specialty!
@TheASNR
@theASFNR
@TheAJNR
@MDAndersonNews
What an incredible honor to meet Dr. Max Wintermark, Editor-in-Chief of
@TheAJNR
! His expertise and dedication to advancing the field of
#neuroradiology
are truly inspiring.
#ASNR23
1
4
29
2
9
62
One of the most amazing sunsets I have ever seen! Camera just doesn’t quite capture the pink to blue hues over the fall mountain colors!
3
0
62
A nice surprise gift of gratitude arrived today from
@MayoClinic
! Items representing all of our campuses from Midwest, Florida, Arizona, London, and Abu Dhabi! Grateful to have an employer that looks after employees in these difficult times!
#MayoClinicFlorida
2
2
61
Looking forward to joining
@SiemensHealth
in Germany to discuss exciting developments in
#7T
MRI! Many great things on the horizon and we are so excited about new areas of impact in our clinical practice!
1
0
62
Congratulations to
@jsandhu11
, our new
#MayoClinicFlorida
Neuroradiology Division Chief! 🥳 Big shoes to fill after Vivek Gupta did amazing job building education & innovation powerhouse during his term, but no doubt Dr. Sandhu will lead us to more great things!
@MayoRadiology
4
4
61
If you are curious about the value of “in-person” meetings…this is it! I always come away with some of the most important career and life advice I have ever received! You won’t find a greater group of people and supporters than
#NeuroRad
(bias alert)!
#ARRS22
4
2
60
Excited to offer 2 post-doc positions at
#MayoClinicFlorida
Radiology! Particularly seeking candidates with expertise in ultra-high field MRI, radiochemistry, AI, or quantitative & functional neuroimaging. More details and application below!
@MayoClinic
4
32
61
Don’t fall victim to satisfaction of search (or my biggest pet peeve, the epidemic overdiagnosis of “NPH)!
3
15
59
On my way to Germany ✈️ and who do I run into in the nation’s capital? None other than the boss and legend himself
@DoctorQMd
!
#MayoClinicFlorida
🧠
4
0
57
I used to think physician reviewers were tough. Then I had an MR physicist attach a PDF document of their comments…
#7T
#MRI
#NeuroRad
#AcademicTwitter
#MedTwitter
3
1
58
Great to have Dr. Mikulis & Dr. Fisher join us for launch of our
#7T
RespirAct system, first 7T install in North America! Another milestone for our 7T program that will allow unprecedented exploration of cerebrovascular physiology & pathology at
#MayoClinicFlorida
!
@MayoRadiology
2
10
57
Exciting work on photon-counting CT with my colleague John Murray for assessing direction electrodes! Reliance on streak artifact from electrodes is challenging with multiple electrodes—why not just directly reconstruct the electrode?! Amazed by advantages of photon CT!
2
8
58
Check out our new article in
@Brain1878
showing added benefit of pallidothalamic stimulation in
#DBS
for dystonic tremor compared to essential tremor!
@MayoRadiology
@UFMDC
@RobertSEisinger
@MichaelOkun
@KDFooteMD
@OkromelidzeLela
@SeizureSurgeon
3
20
56
Thank you so much
@UCSFimaging
for this kind and thoughtful gift! Was an honor to join you!
@CMGlastonbury
@vinil_shah
@NeuroDx
@YiLiMD
@PratikMukhMDPHD
@BhavyaRehaniMD
@LizzRad
@UCSF
@MayoRadiology
0
2
57
Kicking off our 7T Summit Meeting at
#MayoClinicFlorida
to review many amazing success stories of past year, updates on new development projects, and planning the future of clinical 7T!
@MayoRadiology
@MayoClinicNeuro
@jsandhu11
@VishalPatel_MD
0
12
57
A beautiful day today in Lisbon 🇵🇹 for Day 1
@ISMRM
Ultra-High Field Workshop! Thank you to
@HighOnField
and
@k_markenroth
for the opportunity to participate in this wonderful event!
3
4
54
Excited to share our results of first controlled trial of tractography-based
#DBS
in essential tremor in
@TheNeuroradJour
! Unfortunately cut short due to COVID, but connectivity guided programming > standard-of-care and sham @ 3 months.
@MayoRadiology
2
8
54
Honored to be selected as a finalist for the 2023 Top Images in
@radiology_rsna
with
@AmitDesaiMD
for work on ultra-high res 7T MRA with compressed sensing! Thank you to the awesome
@radiology_rsna
In Training Editors!
#MayoClinicFlorida
#NeuroRad
1
7
54
Use FGATIR, EDGE, LAMA, or other T1 inv images? Wish you could get them all in 1 scan? Introducing ingenious work by
@VishalPatel_MD
streamlining our synthetic T1 inversion work into real-time viz tool! See new publication below & link to download in 🧵
1
12
54
Don’t mess with
#Gryffindor
finest!
#Halloween2022
Happy
#Halloween
!! 🎃
I surprised my daughter this year by dressing up to match her theme!
My most elaborate costume but I will be picking spirit gum out of my beard until retirement!
3
0
72
5
1
54
7T neuromelanin imaging for diagnosis of
#ParkinsonsDisease
now available! 7T NM imaging is a highly accurate biomarker for PD.
@dhairyalakhani
has done a great job with this project! A few key observations...
@Nature
@MayoRadiology
2
16
54
Great overview of the status and future of clinical applications of structural & functional connectivity by Wu et al. A tremendous undertaking by
@HarithAkram
and team!
@FranciscaFFerr
@foxmdphd
@andreashorn_
2
11
52
We are thrilled to welcome a new research scientist, Dr. Sina Straub, to our growing
#MayoClinicFlorida
7T MRI team! Dr. Straub joins us from the German Cancer Research Center & brings a wealth of experience in ultra-high field QSM & quantitative neuroimaging to our group!
#7T
1
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